#1 Substance Abuse Disorder Billing Services in Richardson, Texas

 

#1 Substance Abuse Disorder Billing Services in Richardson, Texas

Treatment for SUD typically includes a combination of behavioral therapies, counseling, medication-assisted treatment (MAT), and long-term support. Despite the availability of effective treatments, a large portion of individuals with SUD do not receive the care they need. There are many barriers, such as stigma, lack of access to services, cost, and insufficient insurance coverage, that continue to prevent many from seeking help.

To support recovery and improve access to care in Richardson, Texas, investing in Substance Abuse Disorder Billing Services in Richardson, Texas becomes essential to assist both providers and patients. These services help providers in maintaining a healthy cash flow while reducing the administrative burden on internal staff. Better billing leads to better access to care, better outcomes, and a stronger healthcare system for everyone affected by substance abuse. 

SUD billing refers to the process of coding, submitting, and managing insurance claims for addiction treatment services. It involves using standardized coding systems such as ICD-10-CM for diagnoses and CPT/HCPCS codes for procedures and services delivered. In addition to these, providers must also comply with federal regulations such as HIPAA and 42 CFR Part 2, which are designed to protect the privacy of individuals undergoing addiction treatment. 

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Billing and Coding Guidelines for Substance Use Disorder 

Clean Claims. Quick Reimbursement. Better Recovery for every SUD Patient in Richardson, Texas

Coding Systems and Diagnosis Representation

When billing for SUD services, ICD-10-CM codes identify both the type of substance and the condition's nature, whether it involves abuse, dependence, withdrawal, or associated psychotic symptoms. The most common codes include:

• F10: Alcohol-related disorders
• F11: Opioid-related disorders
• F12: Cannabis-related disorders
• F13: Sedative, hypnotic, or anxiolytic-related disorders
• F14: Cocaine-related disorders
• F15: Other stimulant-related disorders
• F16: Hallucinogen-related disorders
• F17: Nicotine dependence
• F18: Inhalant-related disorders
• F19: Multiple/unspecified substance-related disorders

Every code is further detailed to reflect the patient's condition, such as withdrawal, intoxication, or remission. Using accurate diagnosis codes helps healthcare providers in Richardson, Texas ensure precise billing and minimize claim rejections.

CPT Code Selection 

The healthcare providers in Richardson, Texas use CPT codes to report specific clinical services provided during a patient visit. These codes include:

• 90791, 90792: Psychiatric diagnostic evaluations
• 90832, 90834, 90837: Individual psychotherapy sessions (30–60 minutes)
• 90846, 90847: Family therapy sessions
• 90853: Group therapy sessions
• 90863: Medication management with therapy
• 99408, 99409: Screening and brief interventions for substance use
• G0396, G0397: Short behavioral counseling for substance or alcohol use

Choosing the right code ensures that the services rendered are fully captured and reimbursed appropriately.

Bundled Codes for Office-Based SUD Treatment

CMS provides bundled G-codes for outpatient SUD care, particularly for alcohol and opioid use disorder treatments. These include:

• G2086: 70+ minutes of services in the initial calendar month
• G2087: 60+ minutes in each subsequent month
• G2088: Add-on code for every additional 30 minutes of services

These codes support integrated care plans that involve multiple services, often used by outpatient providers in Richardson, Texas.

Preventive Screening and Brief Intervention

CMS reimburses for early screening and brief behavioral interventions for patients at risk of substance misuse. These include:

• G0442: Annual alcohol misuse screening (15 minutes)
• G0443: Brief in-person counseling (15 minutes)
• G0396: Counseling sessions ranging from 15–30 minutes
• G0397: Counseling sessions over 30 minutes

The primary care clinics in Richardson, Texas often deliver these services, which must be properly documented with time spent and patient risk factors.

Safety Planning and Follow-Up Services

To prevent psychiatric emergencies or overdoses, CMS allows billing for:

• G0560: Development of a safety plan for individuals at risk of suicide or substance use crisis
• G0544: Follow-up contact after an overdose or critical event

These services should be conducted by licensed clinicians in Richardson, Texas, and include proper documentation per CMS policies.

Controlled Substance Monitoring & Lab Services

An effective treatment of substance use disorders, particularly those involving Medication-Assisted Treatment (MAT), includes drug testing. The providers in Richardson, Texas may use:

• CPT 80305–80307: Presumptive drug testing codes (limited to 12 tests per year per patient unless medically necessary)
• HCPCS G0480–G0483: Definitive testing codes based on the number of substances tested

These codes are essential for monitoring compliance in opioid treatment programs and office-based care settings.

Opioid Treatment Program (OTP) Billing 

The billing for OTP services is done using CMS G-codes that cover therapy, medication management, and coordination. The key codes include:

• G2067–G2083: Weekly bundled services for medications like methadone, buprenorphine, and naltrexone
• G2076: Comprehensive intake session, including audio-only telehealth when video isn’t accessible

The clinics in Richardson, Texas must track and document the medication type, dosage, therapy time, and take-home privileges weekly.

Social Determinants of Health (SDOH) Codes

CMS now supports billing for services that address non-clinical needs, such as food insecurity, housing instability, and transportation, through Community Health Integration (CHI) and Principal Illness Navigation (PIN) codes. However, only providers in Richardson, Texas are eligible to bill Evaluation and Management (E/M) codes, or psychologists can use these codes. The licensed Mental Health Counselors (MHCs) and Marriage and Family Therapists (MFTs) in Richardson, Texas are not authorized to bill for these services.

Expanded CMS Guidelines

Starting January 1, 2024, CMS permits MHCs and MFTs to enroll in Medicare and deliver SUD services in Richardson, Texas. To qualify, providers must hold a master’s or doctoral degree, possess a valid Texas license, and have completed at least 3,000 hours of supervised clinical work. Reimbursement for these professionals is calculated at 80% of 75% of the standard Medicare fee schedule, less than that for other non-physician practitioners.

 

Is your SUD Billing Costing you more than you Think?

Claim denials, coding confusion, and missed reimbursements hurt both providers and patients in Richardson, Texas.

Multimodal Treatment Billing Conflicts

SUD treatment in Richardson, Texas may include therapy, MAT, and group counseling provided simultaneously. Billing for these combined services can lead to payment issues and compliance problems without experienced medical billing providers. This requires careful coordination to ensure clean and accurate claims.

Conflicting Payer Views

Some insurers in Texas may view substance use as a personal choice rather than a medical necessity. This stigma results in limited Medicare and Medicaid billing coverage, reduced reimbursement rates, and greater financial burden placed directly on patients seeking recovery services in Richardson, Texas.

Utilization Review Overload

Payers often require frequent utilization reviews (initial, concurrent, and retrospective). Managing these in Richardson, Texas demands constant updates and documentation. Missing even one review can result in denied claims and interrupted care.

Telehealth Billing Limitations

Virtual addiction treatment is growing in Richardson, Texas, but billing telehealth services requires using payer-specific codes, modifiers, and meeting strict documentation and privacy standards. Errors in any aspect can lead to denials or underpayment for legitimate tele-SUD services.

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Key Statistics

Denial Rate Without Expert Billing – 15–20%

Revenue Loss from In-House Billing – Up to 30%

SUD Services Delivered via Telehealth in Richardson, Texas – 45%

Claim Delay Due to Authorization Errors – 14–21 Days

 

Why Substance Abuse Treatment Providers in Richardson, Texas Trust 24/7 Medical Billing Services 

Struggling with Denials? Trust the Best Outsourcing SUD Billing and Coding Company in Richardson, Texas!

COB Tracking and Plan Verification

Our billing professionals verify primary and secondary coverage at intake and monitor changes throughout treatment. We ensure the correct payer order is maintained and all eligible benefits are used before claim submission to avoid rejections for SUD patients in Richardson, Texas.

Denial Reduction

Our denial management team in Richardson, Texas audits and corrects rejected claims, identifies root causes, and improves claim preparation protocols. This can reduce SUD claim denials and increase first-pass acceptance rates by aligning billing workflows with payer trends.

SUD Billing Expertise 

24/7 Medical Billing Services assigns experienced SUD billing experts to your practice in Richardson, Texas. Our specialists understand payer policies, clinical documentation needs, and coding intricacies. This will help you recover 20–30% of revenue often lost due to general billing staff errors.

Payer Rule Monitoring and Policy Alignment

Our compliance team actively tracks payer updates and treatment coverage changes in Richardson, Texas, ensuring billing remains accurate and aligned. We update your coding practices and documentation requirements regularly to match evolving payer standards and reduce audit risks.

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Why Choose 24/7 Medical Billing Services for SUD Billing in Richardson, Texas?

24/7 Medical Billing Services provides end-to-end SUD billing solutions tailored to meet the needs of treatment centers in Richardson, Texas. Our experts understand the nuances of substance use disorder billing, including payer-specific documentation, MAT coding, and therapy billing guidelines. We help reduce claim rejections, shorten AR cycles, and keep your practice compliant with federal and state billing laws. Outsource SUD Billing Services Provider in Richardson, Texas to minimize compliance risk and boost reimbursement speed.

Faster Reimbursements

Our expert coders in Richardson, Texas reduce billing errors by using payer-specific scrubbing tools and cross-checking documentation. As a result, the providers experience faster claim acceptance, minimizing rework and accelerating payment cycles. This ultimately improves cash flow and operational efficiency for addiction treatment programs.

Regulatory Confidence

As a top medical billing and coding company in Richardson, Texas, we manage billing while staying current with 42 CFR Part 2, HIPAA, and CMS updates. Our billing professionals help in avoiding audit risks and penalties through proper documentation and expert-level compliance protocols. 

Lower Overhead Costs 

Outsourcing SUD billing and coding services eliminates the need to maintain in-house billing teams, software licenses, and training budgets. SUD facilities in Richardson, Texas can reduce operational costs by up to 30% annually while gaining access to experienced professionals and advanced tools.

Specialized SUD Coders 

Our certified coders handle detox, MAT, residential, and outpatient claims with a deep understanding of payer guidelines and code sets. This will result in accurate coding, optimized reimbursements, and fewer denials driven by specialists who exclusively focus on substance use disorder treatment billing.

Get Paid Faster for Every SUD Service in Richardson, Texas

Streamline your revenue cycle with our SUD billing and coding experts. We ensure accurate claims, fewer denials, and timely payments for every service you deliver across all stages of patient care.

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FAQs

Is SUD billing allowed for LCSWs and LPCs in Richardson, Texas? 

Yes, if credentialed with the payer and authorized to bill independently.

Are drug screenings required for SUD billing compliance in Richardson, Texas?

Not always, but they support ongoing treatment necessity.

Are there limits on billing SUD therapy per week in Texas?

It depends on payer-specific utilization guidelines.

Can I bill for a no-show appointment in Richardson, Texas?

Only if the payer policy and state guidelines permit billing for missed visits.

Can SUD services be billed retroactively in Richardson, Texas?

Yes, within the payer’s timely filing limits, usually 90–180 days from the date of service.